Ummm... Really.

Is this field really for me?



Yes, no doubt.

Private school's privilege

Private school's privilege.
I can have whatever I want. I can bring supplies as much as I want. I have 1,000mL NS, vial, ampule, all kind of syringes, and even legit heparin and urinary catheter. It's good thing that I can practice at home.

Pressure ulcer

Doesn't it make you really mad at whoever is responsible for this? I do. Every time when I see a picture of pressure ulcer, I get super mad. I decide to not be a nurse who has a patient with pressure ulcer every time. Really. I won't be.

So here are nursing interventions for prevention.

• Maintain clean, dry skin and wrinkel-free linens;
• Appropriately use pressure-reducing surfaces and pressure-relieving devices
• Inspect skin frequently and document risk using a tool such as the Braden scale
• Clean and dry skin immediately following urinary or stool incontinence
• Apply moisture barrier creams to the skin of clients who are incontinent
• Use tepid water (not hot), minimal scrubbing, and pat skin dry.

• Reposition the client in bed at least every 2 hr and every 1 hrs when sitting in a chair. Document position changes;
• Place pillows strategically between bony surfaces
• Maintain the head of the bed at or blow a 30 degree angle (or flat), unless contraindicated, to relieve pressure on sacrum, buttocks, and heels
• Prevent the client from sliding down in bed, as this increases shearing forces that pull tissue layers apart and cause damage
• Lift rather than pull a client up in bed or in a chair, because pulling creates friction that can damage the client's outer layer of skin (epidermis)
• Raise the client's hells off of the bed to prevent pressure on the heels
• Ambulate the client as soon as possible and as often as possible
• Implement active/passive exercises for immobile clients
• Do not massage bony prominences

• Provide adequate hydration (2,000 to 3,000 mL/day) and meet protein and calorie needs;
• Note if serum albumin levels are low (less than 3.5)
• Provide nutritional support as indicated, such as vitamin and mineral supplements, nutritional supplements, enteral nutrition, and parenteral nutrition

(Assessment Technologies Institute)

Here are risk factors for development of pressure ulcers

• Skin changes related to aging
• Immobility.
• Incontinence or excessive moisture.
• Skin friction and shearing.
• Vascular disorders.
• Obesity.
• Inadequate nutrition and or hydration.
• Anemia.
• Fever.
• Impaired circulation.
• Edema.
• Sensory deficits.
• Impaired cognitive functioning, neurological disorders.
• Chronic diseases (e.g., diabetes mellitus, chronic renal failure, congestive heart disease, chronic lung disease).
• Sedation that impairs spontaneous repositioning. (Assessment Technologies Institute)

Bibliography

Assessment Technologies Institute. Fundamentals for Nursing . Ed. Jeanne Wissmann. 6.1. ATI, 2008.

Glycosylated hemoglovin/Hemoglobin A1c: something that can't be faked

"Measurement of glycosylated hemoglobin (also called glycated hemoglobin) provides an index of average glucose levels over the prior 2 to 3 months. Glocuse intereacts spontaneously with hemoglobin in red blood cells to form glycosylated derivatives. The most prevalent species is named hemoglobin A1c. With prolonged hyperglycemia, levels of HbA1c gradually increase. Since red blood cells have a long life span (120 days), levels of HbA1c reflect average glucose levels over an extended time. Hence, by measuring HbA1c every 3 to 6 months, we can get a picture of long-term glycemic control. These measurements are an essential adjunct to daily blood glucose monitoring, but not a substitute. When HbA1c is measured the results have traditionally been expressed as a percent of total hemoglobin in blood. For patients with diabetes, the goal is to keep HbA1c blow 7% of total hemoglobin. According to a 2--8 statement issued jointly by the American Diabetes Association and the European Association for the Study of Diabetes, HbA1c should be measured every 3 months until the value drops to 7% and at least every 6 months thereafter. In addition to being reported as a percent of total glucose, HbA1c results are now also reported as a value for estimated Average Glucose (eAG), expressed as mg glucose/dL of blood (ie, the same units patients see every day when doing SMBG)." (Lehne)


Long story short, do you think you can fake blood glucose as you refrain from eating sweets for few days before you go to meet your doctor? Dude. He will know... He will know as soon as he runs Hemoglobin A1c test. Unless you refrain from eating sweets for 3 months, the result will tell you that you weren't following proper regimen.


Bibliography:
Lehne, Richard A. Pharmacology for Nursing care. St. Louis: Saunders Elsevier, 2010.

Pressure ulcer: Matter of how much you care/assess

AJ: May, I am the most dumb nursing student...
May: You might be the hookest nurse ever but I know at least you won't let your patient to have pressure ulcer I, II, III, IV and that makes you a lot better than most of nurses.

A simple note.

I know that it's better to start study things before test comes, but it's not really easy thing to do. If the day is quite far from the test day it is kind of hard to focus. However, a day before the test, you get to have this super concentration power out of nowhere all of sudden. Anyway, I don't think this week is so tough. Of course I have a test on Thursday and then another test on next Tuesday but I feel good about it. I am trying to be ready for it. You can do it May (✻'w'✻)!

2 weeks from thanksgiving break, 5 weeks from winter break.

Should work on studying hard!

Beta blockers

So, when I see "LOL" all I think about is Beta blockers now.

Homeopathy vs. allopathy

Homeopathy sounds quite nice... but usually it's all about allopathy

Want to major in nursing? Think again.

Since when my life became so tough?
->Answer to that: Nursing.
Who takes classes on day of remembrance?
-> Nursing majors.
Who needs to work 6 to 12 hours in a week without getting paid, but paying to the hospital?
-> Nursing majors.


But who is still going to have a job when WWIII happens?
-> Nursing majors.

Today

Reading 2 chapters from Pharmacotherapeutic.
Foundation of nursing chapter.

I will be just happy to finished those two.

My 3rd patient

Somehow, I get assigned for all the non-believer patients. That's just weird but very interesting :-)

House Season 7

So, so far House season 7 is sweet. I love the fact that House is finally going out with Cuddy and so far it's working out greatly :-)

Cuddy: I sit around on my bureaucratic ass?!
House: I said well-formed. I said well-formed!

Season 7 episode 2 was just great that it made me cry. I never cried before throughout entire 6 seasons in the past but season 7's second episode was just really that great and emotive. I shed tears. I wonder if they have new writers.


PS: Oh, I am definitely catching up with all the vocabs now. It's getting better and better.

(They had to put her in Trendelenburg to promotes perfusion in her vital organs.)

Caffeine

I can feel caffeine kicking in right now. Because I don't drink coffee a lot, if I drink coffee I get tachycardia all the time. I become nervous a little bit... but it clears my mentality so I can stay up later.
Alright. Let's study.

NP or NA?

I think I want to be a nurse practitioner. I know nurse anesthesis gets more money than nurse practitioner but... still... I want to be the one who can benefit people directly.

Still working on vocabs?

Professor: When you work in the ICU, you will see a lot of patients with....blah blah blah
Me: What does she mean by I see you?
AJ: LOL

Professor: Constipation leads to lack of stool....blah blah blah
AJ: What is stool?
Me: Yeah, about that... they use the word "stool" instead of poo, so whenever I see stool in the textbook I just think as poo. See, in this page it says, "put some stools under the immobilized patient..." wait a minute!

Post war trauma and one's psychosocial stage.

My second patient has a mild post war trauma which wasn't recorded in patient information chart. According to the Murphy's law, obviously he participated Korean Civil war in 1950's and I happened to be a Korean. He lost his faith in God during the war. And then he became a pacifist who supports Democratic with passion. Well, I gave him Ego integrity for his psychosocial phase though. He enjoys his life, wishes to live a long and healthy life. He has a positive sense of well-being. He loves watching TV especially about politics, has a great interest in politics (consider that it is hard to find an old person with a hobby with passion). He has good family members who support him well, and he loves them also. He lost his wife a few years ago but still remembers and treasures all the memories of her (also still wears his wedding right everyday). One's lack of religiousness doesn't necessarily related to healthy mentality. At least that's what I think.

Patient #2

Obviously, I am not allowed to tell my patient that he/she is my first or second or whatever patient because I don't want them to be nervous about being treated by an inexperienced student nurse. But they mean a lot to me though. Today is the day that I meet my second patient as a student nurse. You might ask me "What about your first patient?" Oh well... I didn't have much time to write about my first patient but I've thought about him/her a lot. (Excuse me for not providing enough information about my first patient. I want to be always vague about my patient to keep my patient's privacy.) Anyway, I just briefly finished with researching all the information that is related to my second patient. I think I always have hard time with nursing Dx part (diagnosis). This means that I always have hard time with picking a point to improve my patient's condition. Patients tend to have more than one diagnosis (Dx with concurrent Dx) so it makes me more confused because I don't know what to pick. Let's say that my patient was diagnosed with a chest pain and his concurrent Dx is dyspnea. I wouldn't know if I should improve the patient's chest pain or dyspnea. Because you can only pick one condition to work on one at each time. Well, I will see what I can do. I am bringing my NANDA-I book to the hospital today to decided later.

PS: So it was true that geriatric patients are prone to polypharmacy... As you can see in the picture above, the patient that I am working on is taking more than 10 different medicines. Sigh... I need to pay attention about of drug-drug interaction and adverse effects from it now. I am afraid a little bit.

Episode 2. Ambulation

I couldn't quite understand the use of cane while studying Mobility and Immobility chapter. So I practiced ambulation with a cane with my dad's golf club. Now I do understand.

My role?

Role of nurse outside the hospital:
Teach persons within the community
Educate parents
Teach public about over-the-counter (OTC) drugs
Teach people not to share prescriptions

Yeah, I am pretty good at these :-)

Episode 1. BP

I was so bad at measuring BP i.e., blood pressure. On the first day of Health Assessment lab, I was just terrible at it. I tried 5 times on my lab partner, A.J, but had no clue. Why? I simply couldn't hear anything at all through my stethoscope. I had a lot of things in my mind at that time. "Why is it like this? Why can I hear it? Why? God, am I this untalented at nursing? Then why did you let me in this major?" I was quite frustrated... until my lab teacher told that that I was wearing my stethoscope in a wrong way. Oh, hahaha. I was wearing it back to front. No wonder I couldn't hear anything. I tried again and guess what? I could hear his heart beats. I was in ecstasy! I am super good at measuring BP now :-)

Starting as a nursing student

I am a nursing student in a 4 years college and this blog will be my log for my nursing life. I do know well about patient confidentiality so you won't find anything so identifying because I will be always vague about my patients... anyway, Rock on!